Surgery Elsewhere

“Surgeon and Chief Dreamer”

Swiss knife will in einer losen Serie das Dauerbrenner-Thema Ausbildung einmal von einer anderen Seite beleuch- ten und hat Interviews mit führenden Chirurgen aus weit entfernten Ländern geführt. Dr. Oluyombo Awojobi, MB, BS, () FMCS () FWACS, Consultant Rural Surgeon, Awojobi Clinic Eruwa, , Nigeria, berich- tet von seinem Alltag als Chirurg in Nigeria und skizziert das Ausbildungssystem in seinem Land. Die Fragen stell- te Christoph Tschuor.

Dear Dr. Oluyombo, may we ask you to explain who you are? What is the role of clinical and basic research? I was born on 1st March 1951 to Yoruba parents in Kaura Namoda, located While clinical and basic research had been a prominent part of my training as in Northwest Nigeria. I grew up in Southwest Nigeria. I am married to Atinuke, detailed above, there has been a great decline in recent years in the quality a radiographer, and have two sons. Yombo jr. is an electrical engineer and of research. Ayodele is a medical officer. I received my professional training at the Univer- sity College Hospital Ibadan where I graduated in 1975 with a distinction in What function does the surgical society in your country have? surgery. I received the prestigious Adeola Odutola prize for the best final year The National Postgraduate Medical College of Nigeria and the West College medical student. I am a rural surgeon, entrepreneur, innovator, inventor and of Surgeons are responsible for the training of surgeons in Nigeria. However, advocate for surgical education in developing countries. The journal, Africa the output of surgeons has not kept pace with the demand for safe and Health, described me in the September 2005 issue as “the architect, buil- essential surgery. Unfortunately, these colleges have not been pragmatic in der, surgeon, doctor, maintenance man, proprietor, and Chief Dreamer of the training middle-level surgeons, who could solve 80 per cent of the surgical Awojobi Clinic Eruwa (ACE) in rural South West Nigeria. burden in East Africa. In May 2012 we instituted, in our practice, a one-year training in primary surgical care, basic surgical pathology, abdominal ultra- In 1983, I began work as a surgeon at the District Hospital Eruwa in Ibarapa, sonography and hospital administration. The goal of this program is to train located in southwest Nigeria. In 1986 I set up my own practice in Eruwa. I junior colleagues in providing safe and essential surgical care. There have provide a model for sustainable surgical care in rural areas to the Internatio- been six graduates from the program and those currently in training are re- nal Collaboration for Essential Surgery through my life’s work. sponsible for 80 per cent of the 160 major operations performed monthly in our clinic. Please tell us something in general about your country. Nigeria is situated in with the capital, Abuja, in the central part of How are cultural challenges in your country addressed through this the country. It is divided into six geopolitical zones with 36 states and a feder- training structure? al capital territory. The religions are Christianity, Islam and several traditional The surgical fraternity has dissociated itself from the populace. Ordinary religions. The economy is mainly based on the export of crude oil, which Nigerians perform more eye examinations than ophthalmologists and are has led to a great decline in agriculture. About 70 per cent of the estimated responsible for treating faecal fistula following appendectomies. Traditional population of 170 million lives in rural areas which lack basic infrastructure. bone setters continue to maim and cause loss of limbs and lives. 95 per cent of cases brought before the medical disciplinary tribunal are of surgi- How is Medical School organized in your country? cal nature, and most cases involve medical officers who do not have formal There are about 30 medical schools based in the universities and most of surgical training. It should be noted that the first medical degree in Nigeria which are public (federal or state). After six years of primary and secondary permits the graduate to perform any surgery within his/her competence. Sur- education, most students entering medical schools are between 18 and 20 gical training in Nigeria is over forty years old and has been geared towards years old. The duration of education varies widely with the usual six year producing consultant surgeons. Unfortunately there are not enough gradu- program extending to 8 or more years, even if the student is passing all ex- ates to meet the challenge. However, 80 per cent of the surgical challenges ams. This is due to the very frequent labor unrests by the university staff of the populace could be solved by middle- level surgical manpower. The (academic and non-academic). For instance, most Nigerian universities have training structure does not recognize this fact. suffered from closures in excess of two months due to industrial actions by the academic staff. In Europe and in the United States there is a declining number of ap- plicants to surgical training programs. Are you experiencing a similar How do you organize the training of young surgeons (interns/residents) trend in your country? in your country and how long does training take? It is the reverse in Nigeria. Many young doctors want to train as surgeons After a one-year internship and one year of national service, it takes five to and have even passed the primary exams. However, most of them are stalled six years to train a consultant surgeon in Nigeria. The training takes place in in their progress because there are not enough institutions accredited for accredited government tertiary institutions. It involves exposure to both cli- further training. Even the few are not operating maximally due to inefficient nical and basic research and usually results in a dissertation in the specialty, infrastructure and poor work/training ethics. which is mandatory for the final examinations.

Oluyombo Awojobi

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What has the Society of Surgeons done or is doing to increase the at- tractiveness of surgery as a profession? In fact, there are very few surgical mentors in public institutions in Nigeria. The Society of Surgeons in Nigeria is not doing anything to increase the at- tractiveness of surgery as profession. Even in the accredited tertiary hospi- tals, the surgical workload has fallen in recent years with the attendant dimi- nution in cognate skill acquisition. A general surgical unit of two consultants and six residents operate once a week during which they perform two major and four minor surgeries. Unfortunately, all the residents are signed up for having performed the operations. In summary, surgical turf protection is well entrenched in Nigeria.

In Switzerland we are experiencing a strong increase in female medi- cal students. Approximately 60% of all students and 50% of surgical residents are females. Is the amount of female surgeons increasing in your country? Although I do not have the figures, judging from Ibadan medical students who routinely visit our clinic, I will put the ratio of male:female at 3:2. Female surgeons in Nigeria are mostly found in ophthalmology and much fewer in paediatric surgery and neurosurgery.

Finally, following the experience you’ve gathered in your function not only as a surgeon and teacher, but also as President of the Society of Surgeons, what challenges does your institution face in the future and how are you addressing these within your organization? I was the first national secretary of the Association of Rural Surgical Practiti- oners of Nigeria, ARSPON (a-e) and the current secretary of the International Federation of Rural Surgery (www.ifrs-rural.com). By law, it is not permitted to organize a formal training program. So, members like me have resorted to doing that and issuing our certificate of competency. But there is no official recognition of our certificate of competency.

What do surgeons in your country do during their vacation? Most continue to work in their private practices. They hardly travel out of the country for vacation.

What do you and surgeons do in the evenings after work? I write clinical papers, attend to emails and watch National Geographic Channel interspersed by international news, football and music especially from the Nigerian maestro, Fela Anikulapo-Kuti.

Facts and figures: Nigeria Inhabitants: 170 Millions Gross Domestic Product (GDP): 451 billion US Dollars 1 Litre of Milk costs: 2.78 US Dollars 1 Kilo of Bread costs: 2.58 US Dollars 1 Ticket for the Cinema costs: 9.74 US Dollars 1 Package of Cigarettes costs: 1.56 US Dollars 1 Cup of Coffee costs: 2.76 US Dollars 1 Kilometre by Taxi costs: 1.93 US Dollar

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